1. www.gallagherbenefits.com Healthcare Consumerism Mount Vernon Nazarene University – October 2012

2. Common Insurance Terms Deductible Coinsurance Maximum Out of Pocket Procedure Code Diagnosis Code Network Discount Pre-Certification

3. How a Claim Gets Paid Services are received by member at provider – members shows their identification card Provider completes claim form identifying procedure and diagnosis codes and sends it to UMR for processing UMR electronically matches member identification number, procedure and diagnosis codes and electronically adjudicates the claim applying discount and employee cost sharing Payment is sent to provider and Explanation of Benefits is sent to the member

4. Future of Health Plans

5. Factors Influencing Healthcare Costs Technology Advances – MRIs $1890 vs. Chest X-ray $175 Prescription Drugs – Generic vs. Brand Increased Patient Demand – 30% of healthcare treatments viewed as unnecessary Government Regulations & Coverage Mandates – HIPAA, PPACA Increased Financial Pressure on Doctors & Hospitals – malpractice insurance, consolidation Lifestyle Choices – 50% of all healthcare costs stem from preventable lifestyle choices

6. Factors Influencing Healthcare Costs Direct-to-Consumer Marketing –TV Commercials –Magazine Ads –Billboards Increased number of chronic conditions Increased availability and access to care

7. Consumer Tools Discounted Prescription Medications –Wal-Mart - $4/$10 –Kroger - $4/$10 –K-Mart - $5/$10 with Pharmacy Prescription Savings Club Membership –Meijer - Costco – no membership required Websites to Compare Prices –www.healthcarebluebook.comwww.healthcarebluebook.com –www.fairhealthconsumer.orgwww.fairhealthconsumer.org –www.rxaminer.comwww.rxaminer.com Online Drug Stores –www.drugsource.comwww.drugsource.com Physician & Hospital Quality –www.healthgrades.comwww.healthgrades.com –www.hospitalcompare.hhs.govwww.hospitalcompare.hhs.gov –www.umr.comwww.umr.com Consumer Reports Health

8. Consumer Tips Get the Most of Doctor Visits – www.choosingwisely.com www.choosingwisely.com Ask for prescription samples from your physician for short-term medications Ask your physician for copay assistance prescription cards for long-term medications Review medical bills Stay in-network Utilize generics Shop around

9. Additional Tips Prescription Drug costs can change daily and vary widely from store to store Generic drugs are not cheaper than brand name drugs the first six months on the market You can negotiate your provider bills Antibiotics and Prenatal vitamins are FREE at Meijer

10. Questions